Provider Demographics
NPI:1871954735
Name:BERNHARDT, DAKOTA
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:BERNHARDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5524 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53806-9620
Mailing Address - Country:US
Mailing Address - Phone:608-330-1627
Mailing Address - Fax:
Practice Address - Street 1:5524 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53806-9620
Practice Address - Country:US
Practice Address - Phone:608-330-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2328-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant